Falls in MinnesotaFacts on Prevalence Impact and Effective by vmarcelo

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									Falls in Minnesota: Facts on
Prevalence, Impact and
Effective Prevention
  Kari Benson, Minnesota Board on Aging
  Heather Day, Minnesota Department of Health
  Pam Van Zyl York, Minnesota Department of Health
Falls in Minnesota
   Age & Disabilities Odyssey
   Duluth, MN
   August 20, 2007
            Heather Day, RN, MPH
            Minnesota Department of Health
            Falls –
leading cause of serious injury
           Mortality
         Major Trauma
             SCI
             TBI
         Hospitalized
          ED-treated
Leading Causes of Injury Death
in Minnesota

     1) Motor vehicle crashes
     2) Unintentional Falls
     3) Self-inflicted Firearm
     4) Self-inflicted Poisoning
Leading Causes of Hospitalized Injury
Among Persons 65+
Minnesota, 1998 - 2005

   1) Unintentional Falls (66,149)
   2) MV Traffic Crash Occupants (3,677)
   3) Unintentional Poisoning (1,884)
   4) Overexertion (1,531)
   5) Struck By / Against (1,192)
Leading Causes of ED-treated Injury
Among Persons 65+
Minnesota, 1998 - 2005
   1) Unintentional Falls (98,610)
   2) Cut / Pierce (12,059)
   3) Struck By / Against (11,252)
   4) MV Traffic Crash Occupants (10,483)
   5) Overexertion (7,717)
Falls are heterogeneous
      Ladder
      Sports
      Work
      Slip/trip same level
      Mechanical vs. organic
Minnesota’s Rates are
high…


Minnesota’s Rates are
increasing…
Unintentional Fall Death Rates,
United States and Minnesota,
1999-2004
                          12.0
                                                                             Minnesota
                                                                             United States
                          10.0
                                        y = 0.468x + 7.408
       Rate per 100,000




                           8.0


                           6.0

                                                                y = 0.293x + 4.405
                           4.0


                           2.0


                           0.0
                                 1999         2000           2001          2002      2003    2004
                                                                    Year




Rates are Age-Adjusted to US 2000 Standard Population.
Nonfatal Hospital-Treated Falls
by Month of Admission, 65+
Minnesota, 1998-2005
                      40.0
   Rate per 100,000




                      30.0


                      20.0

                                                               All Hospital-treated
                      10.0


                       0.0
                                                         May
                                           Mar.




                                                                        Jul.
                                                  Apr.




                                                                                                    Nov.

                                                                                                           Dec.
                             Jan.




                                                                               Aug.
                                    Feb.




                                                                 Jun.




                                                                                             Oct.
                                                  Month of Admission                  Sep.
Nonfatal Hospital-Treated Falls by
Type and Month of Admission, 65+
Minnesota, 1998-2005
                      25.0
   Rate per 100,000




                      20.0

                      15.0

                      10.0                                     ED-treated only
                                                               Hospitalized only
                       5.0

                       0.0
                                                         May
                                           Mar.




                                                                        Jul.
                                                  Apr.




                                                                                                    Nov.

                                                                                                           Dec.
                             Jan.




                                                                               Aug.
                                    Feb.




                                                                 Jun.




                                                                                             Oct.
                                                  Month of Admission                  Sep.
Of the 5 leading causes…
unintentional injury!
Percentage Change in Death Rates for the Leading Causes of
Unintentional Injury, by Mechanism of Injury –
United States, 1999-2004
Unintentional Fall Death Rates Among
Persons Age 65+,
United States and Minnesota, 1999-2004

                        75.0

                                        y = 3.284x + 50.176
                        60.0
     Rate per 100,000




                                                                               Minnesota
                                                                               United States
                                                                               Linear (Minnesota)
                        45.0
                                      y = 2.0923x + 26.429
                        30.0


                        15.0


                         0.0
                               1999         2000         2001          2002   2003        2004
                                                                Year


Rates are Age-Adjusted to US 2000 Standard Population.
Unintentional Fall Nonfatal
Hospitalization Rates
United States and Minnesota, 1998-2005
                                                                                Minnesota
                       300.0
                                                                                United States

                       250.0
    Rate per 100,000




                       200.0


                       150.0


                       100.0


                        50.0


                         0.0
                               1998   1999   2000   2001   2002   2003   2004    2005
                                                       Year


Rates are Age-Adjusted to US 2000 Standard Population.
Rates are highest in
elders…


Falls in Elders Drive
Overall Rates…
Unintentional Fall
Nonfatal Hospitalization Rates
Minnesota, 1998-2005
                         4000.0

                         3500.0                                                        Male
      Rate per 100,000




                         3000.0                                                        Female
                         2500.0

                         2000.0

                         1500.0

                         1000.0

                          500.0

                            0.0




                                                                                                                                                                           85+
                                  <1

                                       1-4
                                             5-9
                                                   10-14
                                                           15-19
                                                                   20-24
                                                                           25-29

                                                                                   30-34
                                                                                           35-39

                                                                                                   40-44
                                                                                                           45-49
                                                                                                                   50-54
                                                                                                                           55-59
                                                                                                                                   60-64
                                                                                                                                           65-69
                                                                                                                                                   70-74
                                                                                                                                                           75-79
                                                                                                                                                                   80-84
                                                                                     Age Group

Rates are Age-Adjusted to US 2000 Standard Population.
Unintentional Fall
Nonfatal Hospitalization Rates, 0-59
Minnesota, 1998-2005
                         300.0
                                                          Male
                         250.0                            Female
      Rate per 100,000




                         200.0

                         150.0


                         100.0

                          50.0

                           0.0
                                 <1

                                      1-4

                                            5-9

                                                  10-14

                                                            15-19

                                                                    20-24

                                                                            25-29

                                                                                    30-34

                                                                                            35-39

                                                                                                    40-44

                                                                                                            45-49

                                                                                                                    50-54

                                                                                                                            55-59
                                                                     Age Group




Rates are Age-Adjusted to US 2000 Standard Population.
Unintentional Fall
Nonfatal Hospitalization Rates, 50+
Minnesota, 1998-2005
                     4000.0

                     3500.0                           Male
  Rate per 100,000




                     3000.0                           Female
                     2500.0

                     2000.0

                     1500.0

                     1000.0

                      500.0

                        0.0




                                                                                        85+
                              50-54


                                      55-59


                                              60-64


                                                        65-69



                                                                70-74


                                                                        75-79


                                                                                80-84
                                                        Age Group

Rates are Age-Adjusted to US 2000 Standard Population.
Total Acute Care Charges Associated
with Nonfatal Falls Among Persons 65+
Minnesota, 1998-2005

    Hospital Charges = $1,022,083,080
 Range: $83.9 million to $162.1 million per year


 ED Charges = $106,255,555
 Range: $5.8 million to $20.4 million per year
Nonfatal Falls Among Persons 65+:
Hip Fracture and TBI
Minnesota, 1998-2005
        Hip Fracture: N = 24,969
            24,381 hospitalizations
            1,488 ED visits
            Total charges = $61.1 million

        TBI: N = 13,931
            5,281 hospitalizations
            8,649 ED visits
            Total charges = $207.9 million
What’s next…
    Continued Analysis of Hospital Discharge data
      New V code: V15.88 History of Falls


    Collection of hospital & TBI elder falls data
      Body position

      Factors / activity at time of fall
      Height

      Location

      Time of day

      Use of anticoagulant or antiplatelet medication

      Comorbid health conditions
Falls Prevention


   Pam Van Zyl York, MPH, PhD, RD, LN
   Minnesota Department of Health
Falls Prevention and Chronic Disease
Management
     Keys to chronic disease management include
      regular physical activity, medication management,
      education and healthy eating
     80% of those over 65 years have 1 or more chronic
      condition, 65% have multiple chronic conditions
     Those with impaired strength, mobility, balance and
      endurance are twice as likely to fall as healthier
      persons
     Those with more chronic conditions are more likely
      to die or sustain more serious injury when they fall
Chronic Disease in Minnesotans
65 yrs +
    Age related macular degeneration - Approx. 25%
     (nationally)
    Alzheimers’ Disease - 13% (nationally)
    Arthritis - 53%
    Diabetes - 13 %
    Heart Disease – 6+%
    Stroke - 3%
    Osteoporosis – 14.4%
Key Elements of a Falls Prevention
Intervention
     Education
     Exercise to increase lower-body strength and
      balance
     Home and environment assessment and
      modification
     Medication review and modification
     Vision evaluation and correction
     Support for self-management of risk factors and
      fear
     Nutritional considerations?
        Falls Injury Prevention Model – Points of Intervention Continuum
  Safety Promotion                  Primary and Secondary                  Emergency Medical                Rehabilitation                Support in the
This is raising awareness                Prevention                         Services, Primary           Activities are taken to            Community
among the elderly and         Primary prevention focuses on                Care and Acute Care          prevent long-term             After a fall injury,
within society in general     preventing the first occurrence of a fall,   This includes emergency      complications and             appropriate home and
about the burden of           such as risk identification and              response and                 disability after a fall and   medical support and
injury from falls and the     modification. Including in-depth clinical    transportation to hospital   to promote rehabilitation     follow-up is carried out to
need to take steps to         assessment of elderly individuals at risk    without delay,               and re-integration into       enable continued
reduce physical,              of falling by family physicians and other    assessment and               the community. The aim        independence and
behavioral,                   health care professionals, followed by       treatment by physicians      is to maximize the level      quality of life in the
environmental and             treatment of medical factors or              and further treatment        of functioning after a fall   community or long-term
societal risk factors.        modification of environment or               such as orthopedic           and the prevention of         care setting.
Safety promotion              behavior. Treating medical illness,          surgery, if required and     future falls.
includes supporting           adjusting medication, removing slip and      the initiation of
communities in primary        trip hazards from the home, or               rehabilitation. This is
prevention activities and     introducing targeted exercise regimens       followed by investigation
fostering community-          to improve strength and balance are all      and correction of factors
based programs. It also       primary prevention activities.               leading to the fall such
includes changing public      Secondary prevention aims to                 as detection and
values and attitudes so       minimize the injury or complications         stabilization and
that falls and injuries are   once a fall occurs. This may include         treatment of medical
not seen as the result of     teaching elderly how to get up after a       conditions that may have
unavoidable accidents,        fall, fostering bone health through diet,    contributed to the fall.
but are seen as               exercise or drugs to reduce the chance       The result is the
predictable and largely       of fracture and improve strength and         reduction of the future
preventable events.           balance, or promoting personal alarm         morbidity and mortality
                              systems for seniors to alert others          and the improvement of
                              when they have fallen. The aim is to         the outcomes following a
                              prevent an injury or fall in the future.     fall.
 Falls Injury Prevention Model – Points of Intervention Continuum
                   Primary and
                   Secondary Prevention
                   through evidence-
                                                  Emergency
                   based interventions
                                                  medical services,
                   for falls and chronic          primary care and
                   disease                        acute care
Safety promotion
and increasing
awareness among
individuals,
communities and                                       Rehabilitation
providers                                             services




                               Home and medical
                               support in the
                               community
MN Falls Prevention Initiative

     MN Board on Aging, Dept of Health and
      Dept of Human Services
     October 2005: 3-year planning grant from
      U.S. Administration on Aging
     Convening a broad range of public and
      private partners at the state, regional and
      local levels to implement a statewide
      coordinated evidence-based falls
      prevention initiative.
MN Falls Prevention Initiative


           The Vision

 Older Minnesotans will have fewer
    falls and fall-related injuries,
  maximizing their independence
          and quality of life.
MN Falls Prevention Initiative
Objectives
   1. Increase awareness of prevalence and
        risk factors for falls.
   2.   Increase assessment of fall risk.
   3.   Increase availability of evidence-based
        interventions statewide.
   4.   Increase access to these interventions.
   5.   Enhance quality assurance efforts
        related to falls prevention.
Call to Action

   Articulates state “plan” for falls
     prevention and commitment of partners
     to work together

   Provides framework for action by
     professionals and community
     partnerships
MN Falls Prevention Website

   Developed through collaborative effort
    of state partners
   Goal: to make it easy to take action to
    prevent falls
   Consumer and Professional Sections
   Evidence-based Recommendations
Contact Information

   Pam Van Zyl York                 Kari Benson
    Minnesota Department of           State Project Manager
    Health, Division of Health        Minnesota Board on Aging
    Promotion and Chronic             kari.benson@state.mn.us
    Disease
    pam.york@health.state.mn.us

								
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